AccountId: 011433970860
ContactId: 9b6cc173-8e14-4490-8636-82502106d0a0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 415510 ms
Total Talk Time (AGENT): 142983 ms
Total Talk Time (CUSTOMER): 203199 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/9b6cc173-8e14-4490-8636-82502106d0a0_20250207T21:18_UTC.wav
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[AGENT][POSITIVE] Thank you for calling. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling for Doctor [PII]. And please know this call will be recorded and monitored for quality and training purposes. I'm calling to check on a claim status. I'm sorry, I missed your name. Could you repeat that for me?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, you're checking a claim status [PII]?
[CUSTOMER][NEUTRAL] Oh yes.
[AGENT][NEUTRAL] OK. My name is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] First initial last name is [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you'll use my name and today's date as reference for today's call. Can I get the policy number, [PII]?
[CUSTOMER][NEUTRAL] Yes, sir. The policy number is 021-82458.
[AGENT][POSITIVE] And a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. The phone number is [PII] and it is a direct line.
[AGENT][NEUTRAL] OK, thank you. What's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, sure, the patient's name is uh [PII], and the date of birth is [PII].
[CUSTOMER][NEUTRAL] So the
[AGENT][POSITIVE] Alright, thank you for that information and we're checking claim status.
[CUSTOMER][NEGATIVE] It's not.
[CUSTOMER][NEUTRAL] I guess.
[AGENT][NEUTRAL] OK, we can assist with that. What is the date of service and the total charge?
[CUSTOMER][NEUTRAL] Yeah, sure. The date of services.
[CUSTOMER][NEUTRAL] [PII] and the total charge amount is $231 447 cents.
[AGENT][NEUTRAL] 231.47.
[CUSTOMER][NEUTRAL] Oh yes.
[AGENT][NEUTRAL] And the date of service is [PII].
[CUSTOMER][NEUTRAL] Oh yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And is this for an office visit and diagnostic test?
[CUSTOMER][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] So yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] All right, so under this policy, the physician.
[AGENT][NEUTRAL] Or the office visit fee is not covered.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So there was no payment made and then for the two treatment codes, um, this policy has a deductible and so the amounts were applied towards the calendar year deductible under this policy.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 7
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Um, which is, uh, up, it's $1000 per calendar year.
[CUSTOMER][NEUTRAL] OK, may I know the date of this time?
[AGENT][NEUTRAL] Could you repeat that, Mark?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, may I know the received date of this claim, received date.
[AGENT][NEUTRAL] Sure. Sure, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Uh, the claim was received [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Process [PII].
[AGENT][NEUTRAL] And let me know when you're ready for the claim number.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Yes, I'm ready.
[AGENT][NEUTRAL] 347.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 1061.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, thank you so much. And I have the three CPD codes as per my notes let me verify the CPT code 99203. Uh, it was made as the place of service so it's not covered under the patient's policy. Is that correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The CP is not covered. OK. And for the, the, the 73.
[CUSTOMER][NEUTRAL] 564 was uh process for the deductables, is that correct?
[AGENT][NEUTRAL] Applied towards deductible correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And a deductible amount, may I know the deductible amount.
[AGENT][NEUTRAL] It's 1000 a year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I understand. Thank you so much. And
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, and how much the uh patients, patient made so far?
[AGENT][NEUTRAL] Anything else?
[AGENT][NEUTRAL] Of the calendar deductible $462.74.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. I understand. Thank you so much and let me verify the patient account number to you.
[AGENT][NEUTRAL] It's the number that you gave me when you called.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] No, that is not. Oh, that's not. And
[CUSTOMER][NEUTRAL] Could you please uh fax a copy of the UB?
[AGENT][POSITIVE] It was actually mailed to the address that's on your claim, uh, the next business day after it was processed, it's now available to download online. The web address is secured.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And you can use, you can start using the claim number.
[AGENT][NEUTRAL] The patient's first name and the patient's date of birth to download that explanation of benefits and if you need assistance I can help you with that if you don't mind.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Or if you would like
[CUSTOMER][NEUTRAL] No, uh, just.
[CUSTOMER][NEUTRAL] And could you please, uh, yeah, yeah, no, I will just make a note uh note of the hotel name. Could you please provide the current mailing address?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The claims mailing address?
[CUSTOMER][NEUTRAL] Oh yes, currently.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Dash
[CUSTOMER][NEUTRAL] [PII]. The zip code is [PII]. Is that correct?
[AGENT][POSITIVE] Correct. Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And I may know the time you find limit for a claim.
[AGENT][NEGATIVE] Just submit a claim, there's no timely filing?
[CUSTOMER][NEUTRAL] OK, I understand. May I know the call reference?
[AGENT][NEUTRAL] My name in today's date.
[CUSTOMER][POSITIVE] OK, thank you so much, So [PII] for the day. Thank you for your wonderful assistance and you have a great day. Thank you.
[AGENT][POSITIVE] You're welcome, [PII]. Thanks for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Thank you bye bye.